CMS Clashes With Insurers Over Coding

The Centers for Medicare and Medicaid Services says it will be adjusting for private Medicare plan operators’ tendency to “upcode” the severity of plan members’ health problems.

Medicare Advantage plan defenders say they plans may simply be attracting sicker members, or coding members’ conditions more accurately than traditional Medicare plans have been.

But CMS officials say they believe at least some of the coding gap between Medicare Advantage plan members and traditional Medicare plan members is the result of conscious upcoding efforts and that they will adjust Medicare plan reimbursement arrangements according.